Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery

Foldyna, Borek; Mueller, Martin; Etz, Christian D.; Luecke, Christian; Haunschild, Josephina; Hoffmann, Ines; Gutberlet, Matthias; Lehmkuhl, Lukas

doi:10.1007/s00330-018-5946-5

Cited by 8 publications

(14 citation statements)

References 26 publications

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“…In the current study, all cases of mediastinitis were accompanied with fluid collection. These findings are necessary for a diagnosis of mediastinitis to be made, and this result is consistent with previous report …”

Section: Discussionsupporting

confidence: 93%

“…These findings are necessary for a diagnosis of mediastinitis to be made, and this result is consistent with previous report. 19,28 Moreover, the patients in this study with hematomas had various grades of capsular ring extent. There were some studies reporting that chronic hematoma may cause various enhancements.…”

Section: Discussionmentioning

confidence: 88%

“…Computed tomography (CT) is an important tool to diagnose mediastinitis and to ascertain if surgical intervention is required. However, some previous studies have reported that CT was useful in diagnosing mediastinitis, but these reports mainly included adult not pediatric patients . In addition, recently, judicious use of antibiotics was reported to be important in preventing the increase of antibiotic‐resistant bacteria .…”

mentioning

confidence: 99%

“…However, some previous studies have reported that CT was useful in diagnosing mediastinitis, but these reports mainly included adult not pediatric patients. 1,2,4,[14][15][16][17][18][19] In addition, recently, judicious use of antibiotics was reported to be important in preventing the increase of antibiotic-resistant bacteria. 20,21 Antibiotics for mediastinitis are usually administered for a long period; therefore, judicious use is important to decrease costs.…”

mentioning

confidence: 99%

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Computed tomography findings of mediastinitis after cardiovascular surgery

Hosokawa

Yamada

Tanami

et al. 2020

Pediatrics International

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Background To our knowledge, no systematic study has been conducted on computed tomography (CT) imaging of mediastinitis in children post‐cardiovascular surgery. We aimed to assess the CT findings of pediatric patients diagnosed with mediastinitis after cardiovascular surgery. Methods We included 28 pediatric patients with suspected mediastinitis after undergoing cardiovascular surgery and who underwent CT. Patients were divided into a group with mediastinitis requiring antibiotic therapy (n = 15) confirmed by positive bacterial culture from the mediastinum and a group without mediastinitis (n = 13). Fisher's exact test was used to compare the following CT findings between the two groups: (i) mediastinal fluid collection; (ii) free gas bubble within fluid collection; (iii) sternal destruction; and (iv) capsular ring enhancement. The enhancement extent was categorized into the following four grades: whole rim enhancement, >50% of the rim enhancement, <50% of the rim enhancement, and no rim enhancement. A receiver operating characteristic curve analysis was performed to establish a cut‐off point for obtaining the maximum diagnostic accuracy. Results A significant difference was observed between patients, with and without mediastinitis in sternal destruction (73.6% vs 0%, P = <0.0001) and capsular ring enhancement (100.0% vs 38.5%, P = 0.0004). By using a cut‐off grade of the whole rim enhancement, the estimated sensitivity and specificity for mediastinitis diagnosis were 100% and 92.3%, respectively. Conclusion Computed tomography findings of sternal destruction and capsular ring enhancement were observed more in patients with mediastinitis than in those without mediastinitis, and should be assessed carefully to diagnose mediastinitis accurately in pediatric patients who have undergone cardiac surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Computed tomography findings of mediastinitis after cardiovascular surgery

Hosokawa

Yamada

Tanami

et al. 2020

Pediatrics International

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“…Conventional thoracic radiography can highlight the indirect signs of mediastinitis such as subcutaneous emphysema, lateral or anterior tracheal deviation, and pleural fluid collections [4, 31].…”

Section: Microbiology Of Mediastinal Infectionmentioning

confidence: 99%

Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

Mureşan

Mureșan

Balmos

et al. 2018

The Journal of Critical Care Medicine

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Background Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition. Diagnosis and treatment Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis. The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations. The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage. Conclusions The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.

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